{"id":331,"title":"Claim Intimation form - Group Term Life","purpose":"claim","insurer":{"slug":"indiafirst-life-insurance","name":"IndiaFirst Life Insurance Company Limited"},"source_pdf":"https://www.indiafirstlife.com/content/dam/ifliwebsite/in/en/download-center/all-product-related-documents/withdrawn-products/claim-intimation-form-group-term-plan-group.pdf","sha256":"598c124219842e3215acc53740a5bf679054952d132465d00a4b19b7493f99c6","pages":2,"collected":"2026-10-17","instructions":{"about":"This form is used by the claimant or nominee to intimate a death claim under a Group Term Life insurance policy.","notes":["All claim payments will be made through electronic fund transfer only.","Issuance of this form does not amount to admission of any claim or liability by the insurer.","Attach original death certificate and all required documents to help process the claim promptly.","IndiaFirst does not demand any fees to process claims; contact customer service if such demand is made.","It is mandatory to provide a cancelled cheque and copy of bank passbook & account statement for payout.","Use the mode of payment selected in this form for all payouts.","The company may call for additional documents or information depending on the cause or nature of claim."],"title":"Claim Intimation form - Group Term Life","submit":{"to":"IndiaFirst Life Insurance Company Ltd.","how":"post / e-mail / upload","address":"12th and 13th Floor, North [C] Wing, Tower 4, Nesco IT Park, Nesco Center, Western Express Highway, Goregaon (East), Mumbai – 400063\nE-mail: customer.first@indiafirstlife.com"},"purpose":"claim","sections":[{"title":"Claimant's/ Nominee's Details","fields":[{"help":"","type":"phone","label":"Contact No: Residential","options":[],"required":null,"pdf_field":""},{"help":"","type":"email","label":"E Mail ID:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Name:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Current Residential Address:","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Mobile:","options":[],"required":null,"pdf_field":""},{"help":"Bank account number of claimant","type":"text","label":"A/C No:","options":[],"required":null,"pdf_field":""},{"help":"Attach copy of Bank Passbook or Bank Statement","type":"text","label":"Bank Account Details of Claimant: Bank Name -","options":[],"required":null,"pdf_field":""},{"help":"Format DD/MM/YYYY","type":"date","label":"Date of birth:","options":[],"required":null,"pdf_field":""},{"help":"Bank IFSC code","type":"text","label":"IFSC Code","options":[],"required":null,"pdf_field":""},{"help":"Tick the relevant relationship and specify if Others","type":"choice","label":"Claimant’s relationship with the life assured  ( Check Relevant Option):","options":["Son","Daughter","Father","Mother","Spouse","Others ( Please specify)"],"required":null,"pdf_field":""}],"filled_by":"claimant or nominee"},{"title":"Doctor's details (In case of death to medical reason)","fields":[{"help":"","type":"text","label":"Name of the doctor/ hospital","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address","options":[],"required":null,"pdf_field":""},{"help":"","type":"phone","label":"Phone Number","options":[],"required":null,"pdf_field":""},{"help":"Format DD/MM/YYYY","type":"date","label":"Date of Consultation","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Reason for consultation/admission","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant or nominee"},{"title":"Master Policyholder's details","fields":[{"help":"","type":"text","label":"Master Polocyholder's Name:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Membership no / Certificate of Insurance no:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Group Term Life Policy number:","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant or nominee"},{"title":"Member's (Life Assured) Details","fields":[{"help":"","type":"text","label":"Name:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Address:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"City:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"State:","options":[],"required":null,"pdf_field":""},{"help":"","type":"number","label":"Pin code:","options":[],"required":null,"pdf_field":""},{"help":"","type":"amount","label":"Sum Assured:","options":[],"required":null,"pdf_field":""},{"help":"Format DD/MM/YYYY","type":"date","label":"Date of death:","options":[],"required":true,"pdf_field":""},{"help":"Format DD/MM/YYYY","type":"date","label":"Date of birth:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Place of death:","options":[],"required":null,"pdf_field":""},{"help":"","type":"choice","label":"Gender:","options":["Male","Female"],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Cause of death:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Occupation:","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant or nominee"},{"title":"Accident details (in case of death due to accident)","fields":[{"help":"Format DD/MM/YYYY","type":"date","label":"Date ofAccident :","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Place:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Cause of death:","options":[],"required":null,"pdf_field":""},{"help":"Tick if applicable","type":"checkbox","label":"Road accident:","options":["Road accident"],"required":null,"pdf_field":""},{"help":"Tick if applicable","type":"checkbox","label":"Accident at home:","options":["Accident at home"],"required":null,"pdf_field":""},{"help":"Tick if applicable","type":"checkbox","label":"Accident at work:","options":["Accident at work"],"required":null,"pdf_field":""},{"help":"Tick if applicable","type":"checkbox","label":"Homicide:","options":["Homicide"],"required":null,"pdf_field":""},{"help":"Tick if applicable and specify","type":"checkbox","label":"Other:","options":["Other"],"required":null,"pdf_field":""},{"help":"","type":"text","label":"In case of other, please specify:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"How did the accident occur ?","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant or nominee"},{"title":"Police Investigation details (Applicable in case of death due to accident)","fields":[{"help":"Attach copies of FIR, police inquest report, Panchnama, post mortem report etc.","type":"text","label":"Police Station:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"FIR/ Case No:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Findings:","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant or nominee"},{"title":"Claims process requirements","fields":[{"help":"","type":"text","label":"Bank name","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Account number","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Type of account","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"MICR Code","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"IFSC code","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Name as per Bank Records","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Branch","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant or nominee"},{"title":"Signatures and Declarations","fields":[{"help":"","type":"text","label":"Name and designation:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Company seal and address:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Contact Details:","options":[],"required":null,"pdf_field":""},{"help":"","type":"signature","label":"Signature of the Claimant/ Nominee - Mandatory","options":[],"required":true,"pdf_field":""},{"help":"Format DD/MM/YYYY","type":"date","label":"Date:","options":[],"required":true,"pdf_field":""},{"help":"","type":"text","label":"Name and address:","options":[],"required":null,"pdf_field":""},{"help":"","type":"text","label":"Contact Details:","options":[],"required":null,"pdf_field":""},{"help":"","type":"signature","label":"Signature :","options":[],"required":null,"pdf_field":""},{"help":"Format DD/MM/YYYY","type":"date","label":"Date:","options":[],"required":null,"pdf_field":""}],"filled_by":"claimant or nominee and group policy holder"}],"deadlines":[],"applies_to":"Group Term Life policies","attachments":["Copy of Bank Passbook / Bank Statement","Completely Filled and Signed Claim Intimation Form","Original Death Certificate","Bank Application form (Applicable only for Jeevan Abhaya & Jeevan Suraksha)","Health declaration form (Applicable only for Jeevan Abhaya & Jeevan Suraksha)","Nomination form (Applicable only for Jeevan Abhaya & Jeevan Suraksha)","Copy of Leave Records (Applicable only for Employer Employee Group Term Life)","Copy of Certificate of Insurance (Applicable only for Employee Group Term Life)","Copy of Identification & Address proof of Nominee/Claimant","Copy of Bank Pass book of Nominee/Claimant along with Cancelled Cheque","Bank A/C statement of Life Assured showing the Insurance Premium Debit (Applicable only for Jeevan Abhaya & Jeevan Suraksha)","Copies of First Information Report Duly attested by Police Officials (in case of unnatural death)","Copies of Post Mortem Report Duly attested by Police Officials (in case of unnatural death)","Copies of Panchanama Report Duly attested by Police Officials (in case of unnatural death)","Discharge / Death Summary of Hospital (if treated for illness related to cause of death)","All investigation/Diagnostic Reports (if treated for illness related to cause of death)","Hospital Summary/Indoor Case Sheets (if treated for illness related to cause of death)"],"declarations":["I am the rightful claimant/ nominee of this plan and the details provided are true to the best of my knowledge.","I authorize any hospital, medical practitioner, insurance company, government organization, employer or other institution to provide IndiaFirst with medical and other information about the deceased.","I agree to help IndiaFirst gather any information needed to process this claim.","I declare that the company shall not be responsible for non-credit or delayed credit of my bank account due to incorrect details provided by me."],"dropped_labels":2},"pdf_fields":null,"fillable_pdf":false,"send_to":[{"purpose":"claim","channel":"address","value":"IndiaFirst Life Insurance Company Ltd., 12th and 13th Floor, North [C] wing, Tower 4, Nesco IT Park, Nesco Center, Western Express Highway, Goregaon (East), Mumbai – 400063","label":"Claims documents submission address","level":null,"hours":null,"applies_to":"life","source_url":"https://www.indiafirstlife.com/claims/claims-overview","quote":"ntative will reach out to you soon to guide you through our life insurance plans that fit your life goals\nHome\nClaims - IndiaFirst Life Insurance\nClaims Overview\nLife Insurance Claim Process\nAt IndiaFirst Life, we stand firmly with our customers in their hour of grief. We provide a streamlined claim registration and settlement process, ensuring a worry-free future for our customers. With a focus on efficiency","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"email","value":"claims.support@indiafirstlife.com","label":"Claims support email","level":null,"hours":null,"applies_to":"life","source_url":"https://www.indiafirstlife.com/claims/claims-overview","quote":"rstlife.com/claims/claims-overview/register-claim-online\n\"\nEmail:\nShare soft copies of all the mandatory documents at '\nclaims.support@indiafirstlife.com\n'\nCall:\nContact us at 1800-209-8700 for assistance. Our representative will guide you through the claim process registr","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"phone","value":"1800-209-8700","label":"Claims assistance phone","level":null,"hours":null,"applies_to":"life","source_url":"https://www.indiafirstlife.com/claims/claims-overview","quote":"\"\nEmail:\nShare soft copies of all the mandatory documents at '\nclaims.support@indiafirstlife.com\n'\nCall:\nContact us at 1800-209-8700 for assistance. Our representative will guide you through the claim process registration.\nVisit Us:\nDrop soft/hard copi","fetched_at":"2026-10-20"},{"purpose":"claim","channel":"url","value":"https://www.indiafirstlife.com/claims/claims-overview/register-claim-online","label":"Register your claim online","level":null,"hours":null,"applies_to":"life","source_url":"https://www.indiafirstlife.com/claims/claims-overview","quote":"Claim Process\nClaim Documents\nFAQs for Claim\nStep 1. Claim Registration\nAnswer\nOnline:\nRegister your claim online at \"\nhttps://www.indiafirstlife.com/claims/claims-overview/register-claim-online\n\"\nEmail:\nShare soft copies of all the mandatory documents at '\nclaims.support@indiafirstlife.com\n'\nCall:\nContact us at","fetched_at":"2026-10-20"}],"how_to_use":"Ask the user for each field in order, in plain words; never invent an answer. Labels are as printed. If fillable_pdf is true, pdf_fields gives the PDF's own field names so the file can be filled directly. The printed form decides if anything differs.","url":"https://indiainsurances.com/forms/indiafirst-life-insurance/331-claim-intimation-form-group-term-life"}